Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data From the Park-Reeves Syringomyelia Research Consortium - PubMed (original) (raw)

Multicenter Study

. 2021 Jan 13;88(2):332-341.

doi: 10.1093/neuros/nyaa460.

Alexander T Yahanda 1, Cormac O Maher 2, Gabrielle W Johnson 1, Laurie L Ackerman 3, P David Adelson 4, Raheel Ahmed 5, Gregory W Albert 6, Phillipp R Aldana 7, Tord D Alden 8, Richard C E Anderson 9, Lissa Baird 10, David F Bauer 11, Karin S Bierbrauer 12, Douglas L Brockmeyer 13, Joshua J Chern 14, Daniel E Couture 15, David J Daniels 16, Robert C Dauser 17, Susan R Durham 18, Richard G Ellenbogen 19, Ramin Eskandari 20, Herbert E Fuchs 21, Timothy M George 22, Gerald A Grant 23, Patrick C Graupman 24, Stephanie Greene 25, Jeffrey P Greenfield 26, Naina L Gross 27, Daniel J Guillaume 28, Gabe Haller 1, Todd C Hankinson 29, Gregory G Heuer 30, Mark Iantosca 31, Bermans J Iskandar 5, Eric M Jackson 32, Andrew H Jea 3, James M Johnston 33, Robert F Keating 34, Michael P Kelly 35, Nickalus Khan 36, Mark D Krieger 37, Jeffrey R Leonard 38, Francesco T Mangano 12, Timothy B Mapstone 27, J Gordon McComb 37, Arnold H Menezes 39, Michael Muhlbauer 36, W Jerry Oakes 33, Greg Olavarria 40, Brent R O'Neill 29, Tae Sung Park 1, John Ragheb 41, Nathan R Selden 10, Manish N Shah 42, Chevis Shannon 43, Joshua S Shimony 44, Jodi Smith 3, Matthew D Smyth 1, Scellig S D Stone 45, Jennifer M Strahle 1, Mandeep S Tamber 46, James C Torner 39, Gerald F Tuite 47, Scott D Wait 48, John C Wellons 43, William E Whitehead 17, David D Limbrick 1

Affiliations

Multicenter Study

Occipital-Cervical Fusion and Ventral Decompression in the Surgical Management of Chiari-1 Malformation and Syringomyelia: Analysis of Data From the Park-Reeves Syringomyelia Research Consortium

Travis S CreveCoeur et al. Neurosurgery. 2021.

Abstract

Background: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology.

Objective: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD.

Methods: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD.

Results: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P = .011), Klippel-Feil (2/10, P = .015), and basilar invagination (3/12, P < .001) were increased within the OCF group, whereas only basilar invagination (1/4, P < .001) was increased in the OCF/VD group. Clivo-axial angle (CXA) was significantly lower for both OCF (128.8 ± 15.3°, P = .008) and OCF/VD (115.0 ± 11.6°, P = .025) groups when compared to PFD-only group (145.3 ± 12.7°). pB-C2 did not differ among groups.

Conclusion: Although PFD alone is adequate for treating the vast majority of CM-1/SM patients, OCF or OCF/VD may be occasionally utilized. Cranial base and spine pathologies and CXA may provide insight into the need for OCF and/or OCF/VD.

Keywords: Chiari malformation; Clivo-axial angle; Craniovertebral junction; Occipital-cervical fusion; Syringomyelia; Ventral brainstem compression; pB-C2.

Copyright © 2020 by the Congress of Neurological Surgeons.

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Graphical Abstract

Graphical Abstract

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FIGURE.

Flowchart depicting the study cohort.

References

    1. Martin JE, Bookland M, Moote D, Cebulla C. Standardized method for the measurement of grabb's line and clival-canal angle. J Neurosurg Pediatr. 2017;20(4):352-356. -PubMed
    1. Bollo RJ, Riva-Cambrin J, Brockmeyer MM, Brockmeyer DL. Complex chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion: clinical article. J Neurosurg Pediatr. 2012;10(2):134-141. -PubMed
    1. Hankinson TC, Grunstein E, Gardner P, Spinks TJ, Anderson RCE. Transnasal odontoid resection followed by posterior decompression and occipitocervical fusion in children with chiari malformation type I and ventral brainstem compression. J Neurosurg Pediatr. 2010;5(6):549-553. -PubMed
    1. Khalsa SSS, Siu A, DeFreitas TA et al. Comparison of posterior fossa volumes and clinical outcomes after decompression of chiari malformation type I. J Neurosurg Pediatr. 2017;19(5):511-517. -PubMed
    1. Brockmeyer DL. The complex chiari: issues and management strategies. Neurol Sci. 2011;32(Suppl. 3):S345-S347. -PubMed

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